[Cerebral ischemia--challenges and perspectives]

The only treatment for acute ischaemic stroke patients that presently has proven efficacy is intravenous thrombolysis with rt-PA within 3 hrs of onset. However, only at most 5% of the patients are eligible for this therapy. It remains therefore of foremost importance to develop efficacious neuroprotective agents for ischaemic stroke. Unfortunately, despite proven efficacy in the laboratory animal, all clinically-tested neuroprotectants have failed to show significant benefit in well-powered randomized clinical trials. In this article, the possible causes for this situation--either at the level of the design of clinical trials or that of the pre-clinical evaluation--are reviewed, and a number of measures that could be taken to try and solve this awkward situation are proposed.